Stefan Gjurevski - Muscular Dystrophy Type Duchenne (Macedonia) Posted on December 27, 2013

Name: Stefan Gjurevski
Sex: Male
Age: 21 years old 
Nationality: Macedonia   
Diagnose: Muscular Dystrophy Type Duchenne
Admission Date: 2013-11-17
Days Admitted to the Hospital: 28 days

Before treatment:
When the patient was 4 years old, he fell down frequently. He showed weakness of the lower limbs. As he did a series of examinations and muscle biopsy was conducted and he was then diagnosed with muscular dystrophy, type Duchenne. The disease progressed gradually. The weakness of his lowers limbs aggravated, his muscles were atrophied together with the muscles of his pelvic girdle. He had to use wheelchair when he was ten and he was not able to walk completely. Later on, he began to feel the weakness of his upper limbs and the muscles of his upper limbs appeared atrophy and difficulty to move. At present, he cannot take care of himself completely. The muscles of his shoulder girdle, pelvic girdle and four limbs were weak accompanied with serious atrophy. The joints of his elbows, hip and knees were contracted and the mobility was very limited. He felt no difficulty in breathing. He was able to keep himself in a seated position and had a good control of his head movement. He was not able to turn over, sit-up, stand or walk by himself.

Admission PE
BP: 130/87mmHg, Hr 81/min. The temperature of the patient was 36.1 degree. His skin was normal, with no petechia or yellow stains. The respiratory sounds in both lungs were clear, with no obvious dry or moist rales. The sound of his heart was strong, with no obvious murmurs. His abdomen was cup-shaped and soft, with no pressing pain or rebound tenderness. The shape of his liver and spleen was normal with superficial palpation. The muscles of his shoulder girdle, pelvic girdle and all the four limbs had severely atrophied. The muscle tendon of bilateral hip joints, knee joints and elbow joints had contracted. He could not fully straighten the joints of his four limbs. The left elbow joint could stretch to 125°angle while the right elbow joint could stretch to 115°angle. The knee joints could stretch to an 80°angle. Both his wrist joints and ankle joints had no obvious malformation but the joint mobility was still poor. The finger joints of both hands had obviously contracted. The amplitude’s motion was a bit low under his left ventricular wall.

Nervous System Examination:
The patient was alert and he was in good spirits. He spoke fluently. His memory, calculation abilities and orientation were normal. His pupils were equal in size, the diameter was 3.0mm. Both eyeballs could move normally and the pupils reacted normally to light stimulus. His forehead wrinkle pattern was symmetrical. He was able to close his eyes with ease. His bilateral nasolabial sulcus was equal in depth. His teeth were symmetrical. His tongue was at the center of the oral cavity. He had no leaky labial commissure. He could lift his soft palate with ease. The neck muscle was a bit weak so that he could not shrug his shoulders. The muscle strength of both proximal upper limbs was at level 2 while the muscle strength of both distal upper limbs was at level 2+. His grasp power was at level 3-. The grasp power of his right hand was better than his left hand. The muscle strength of his lower limbs was at the same level too. The muscle tone of his four limbs was low, and the tendon reflex could not be elicited. The abdominal reflex of the right side could be elicited slightly while that of the left side could not be elicited. Bilateral palm jaw reflex was negative. Bilateral Hoffman sign was negative. Bilateral Rossilimo sign was negative. Bilateral Babinski sign was negative. His deep or shallow sensation and his fine senses were normal. He could not do the finger-to-nose test, digital opposition test or rapid rotation test on both sides. He could not perform the heel-knee-shin test. There were no signs of meningeal irritation. The laboratory examination after admission showed his ALT and Creatine Kinese higher than normal range.

Treatment:
We initially gave Stefan Gjurevski a complete examination. He received treatment to restore and regenerate muscle and neural cells and also activate his autologous stem cell. We protected his liver, reduced the creatine kinase level, and improve his blood circulation in order to increase the blood supply to the damaged neurons. The essence of increased blood supply to the neurons is to nourish them. This was accompanied by daily physical rehabilitation.

Post treatment:
At present, the patient's condition is better than before. He can finish his rehabilitation training with ease and his exercise endurance has increased. His appetite is better than before. His defecation is normal. He can perform digital opposition test more flexible than before. His wrist joints move more flexible than before. His right forearm pronation and supination have been better than before. He can put his knees together easier than before. His left elbow joint can straighten up to 130° angle while the right side can straighten up to 135°. The knee joint can straighten up to 90°. The muscle strength of both distal lower limbs has improved. The patient himself feels that he swallows easier than before. The muscle strength to shrug shoulders has improved. The muscle strength of his lower limbs has reached level 3. The muscle mass of proximal pelvic girdle and shoulder girdle has increased. He does not feel tired as before when he does the rehabilitation training. His liver function has improved than before and CK level has decreased. The treatment plan has been completed and discharge has been permitted. His swallowing ability has increased than before. The muscle strength is stronger than before when he shrugs his shoulder. The liver function is better and the creatine kinase has greatly decreased.

2014-02-17

Stefan's mother Mrs.Marika Alcheva-Gjurevska email to us:

Subject: patient Stefan Gjurevski from Macedonia
Dear Dr.Wu,

I am writing with regard to your patient Stefan Gjurevski,from Macedonia.He was staying in your hospital with his parents from 17Nov2013

to 15Dec2013.Since he left your hospital he has been taking the medicines and doing exercises.So far,he has put on 7 kg since last time we

weighed him in your hospital,2 months ago.Also,he has done some other improvements,he can open his hands wider,he can lift his arms a

little higher than before and he feels stronger.We know that we can expect more improvements after 3 months.

He had his blood test done a few days ago.We would highly appreciate if you could check his blood test list (enclosed in attachments together

with 2 photos of Stefan taken today) and inform us on your opinion about CK level and other things.Also,send us your further instructions if you have any,please.

With best regards

yours sincerely,

Stefan's mother Mrs.Marika Alcheva-Gjurevska